Young adults with chronic kidney disease: An exploration of their relationships and support networks.

BACKGROUND: Young people with chronic kidney disease (CKD) have a number of key issues and life changes to manage while also possibly transitioning into adult care. During this time, the nature of their support networks including, social, romantic, family and health care relationships, is changing. OBJECTIVE: To explore these young people's experience and perceptions of their past, current and future relationships and support networks. DESIGN: Qualitative study. PARTICIPANTS AND METHODS: Fourteen young adults (8 male, 6 female, aged 18-26 years) with CKD Stages 3-5 participated. Semi-structured interviews were conducted in order to explore the relationships (friends, family and partners) of young adults with CKD at two UK NHS hospitals. These were transcribed and thematically analysed. RESULTS: There were four themes identified. 'Disclosure-To tell or not to tell?' identified the challenges young adults face when disclosing their condition to friends and prospective partners. 'Managing support networks' showed that participants appreciated support from other young adults with CKD but also desired just 'being normal' with their friends. While family support is still significant and much appreciated, some young adults also found it harder to develop their independence. 'Relationship strains and carer needs' highlights the impact of CKD on all relationships. Participants were also aware of the needs of their 'carers'. In 'Happy ever after?' young adults expressed concerns about meeting a partner and having children. CONCLUSIONS: Young adults with CKD need support in helping them manage new and existing relationships, at a time where relationships are taking on different forms and significance. Moreover, support needs for young adults extend beyond the patient, to those who support them; support services need to reflect this.

"Extracaval shepherd's crook" sign: a characteristic radiographic sign of central venous catheter placement in the right internal thoracic vein.

Inaccurate positioning is a well-known and documented complication of central venous catheterization. Inadvertent placement of a central venous catheter into the right internal thoracic vein has been reported in the literature; however, the characteristic radiographic appearance for this complication has yet to be described. We report 3 cases that demonstrate central venous catheters improperly terminating in the right internal jugular vein. Characteristic radiographic findings of this altered catheter course are described. Recognition of these characteristic findings should prompt consideration for line repositioning or replacement.